ESTATE PLANNING


Better healthcare using data-driven insights


The NHS estate is under increasing strain due to underinvestment, rising demand, and a £13.8 bn maintenance backlog. While high-quality estate is available, much of it remains underutilised, and optimising these assets is essential as the NHS shifts towards out-of-hospital care. Here, Baxendale Senior consultant, Kelsey Price, and head of Healthcare Estate Planning, Jim Brooks, and Abintra director, Tony Booty, argue that by combining sensor data with local knowledge, organisations can ‘uncover hidden capacity, optimise space, and reduce reliance on outdated buildings’. They explain how the two businesses are ‘helping healthcare organisations make smarter estate decisions’.


The NHS is one of the UK’s largest property owners, managing over 29 million square metres of estate at a cost exceeding £10 bn per year. These buildings are more than just infrastructure – they are the backbone of patient care, enabling safe, high-quality services and driving healthcare transformation. A well-designed, fit-for- purpose estate supports digitally enabled care pathways, enhances patient and staff experience, and unlocks efficiencies in service delivery. Yet, despite its critical role, the NHS estate is in crisis. Decades of underinvestment, growing demand, and competing financial pressures, have left many hospitals, GP surgeries, and community facilities, struggling with ageing infrastructure and mounting maintenance backlogs. The Darzi Report (2024) warns of ‘capital starvation’ across the NHS, highlighting how investment in buildings and equipment has stagnated, while demand for services has surged. The NHS Estates Return Information Collection (2024) reinforces this concern, showing that while staff numbers have grown post-pandemic, investment in estate renewal has not kept pace.


‘Increasingly visible’ consequences The consequences are increasingly visible: leaking roofs, outdated IT systems, and inadequate clinical spaces that fail to meet modern service demands. Since 2021/22, the NHS maintenance backlog has risen by £2.1 bn, while the funding available to address these issues has fallen by


£707 m in real terms (The Health Foundation, 2024). The impact is far-reaching, as patient safety is compromised, staff productivity is hindered, and operational efficiency is at risk.


Simultaneously, demand for healthcare services continues to rise, and the way care is delivered is evolving. The NHS is shifting towards out-of-hospital care, recognising that many patients can be better treated in community and primary care settings rather than hospitals. However, while the overall picture is concerning, there is also opportunity. Despite the estate’s challenges, many high-quality community and primary care buildings exist, but they are not being used to their full potential. These assets represent a critical resource that, if optimised, could relieve pressure on hospitals and improve access to care closer to home. Integrated Care Boards (ICBs) have a pivotal role in ensuring that these assets are utilised effectively. By making better use of modern, high-quality buildings, the NHS can reduce reliance on poor-quality facilities, exit unsuitable sites, and reinvest the proceeds into modern, patient- centred infrastructure.


Delivering the right care in the right place This is not just about estate management, it is about reshaping healthcare for the future, ensuring that the right care is delivered in the right place, at the right time. But why are estates projects so challenging? Several barriers


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100% 80% 60% 40% 20% 0%


0.010


Room booking system Sensor usage Target usage


0.008 60% 0.006 39% 0.004 23% 11% 0.002 68% 60% 61% 50% 70%


Tony Booty 0.000 Hot desks Meeting rooms Clinic rooms Figure 1: Comparing room booking data, sensor usage, and target usage by space type. June 2025 Health Estate Journal 47


As a co-founder and director at Abintra, Tony Booty – who has over 30 years’ built environment experience – helps organisations manage real estate with technology-led solutions that accurately measure space utilisation and the workplace environment. Abintra is a specialist in flexible working technology, which released what it claims was the first practical desk sensor in 2009, ‘since augmented with sensors measuring different kinds of workspaces, as well as environmental parameters such as heat, light, and air quality’. Over 100 corporations worldwide have used Abintra’s survey and permanent management solutions.


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